Organization
PRASANNA LLC
Active
Other names
Alamo Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MANOHAR MIRYALA (OFFICER)
(409) 225-2098
Entity
Organization
Contact information
Practice address
104 GALLERY CIRCLE, STE 104, SAN ANTONIO, TX 78258
(210) 868-6140
(210) 868-6090
Mailing address
104 GALLERY CIRCLE, STE 104, SAN ANTONIO, TX 78258
(210) 868-6140
(210) 868-6090
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150298
—
TX
Enumeration date
06/10/2020
Last updated
04/01/2022
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